C. L. Scaife1, M. C. Mone1, M. E. Bowen1, D. S. Swords1, C. Zhang2, A. P. Presson2, E. W. Nelson1 1University Of Utah,General Surgery/Department Of Surgery,Salt Lake City, UTAH, USA 2University Of Utah,Epidemiology/Department Of Internal Medicine,Salt Lake City, UTAH, USA
Introduction: Central venous access ports (CVAP) are subcutaneously implanted devices used for delivery of long-term chemotherapy. There is a temporal risk for catheter related infection (CRI) to time of insertion (≤ 30 days). Perioperative prophylactic antibiotics (PABX) are often used in high risk populations and to meet Surgical Care Improvement Project standards. We previously reported a study (n=459), with a 2% CRI rate, all occurring in those without PABX. We also surveyed 5,000 members of American College of Surgeons and found that of those respondents placing CVAP (882 of 1,091), 88% gave PABX. Given these data, and growing concerns of antibiotic resistance; we expanded our dataset and employed propensity analysis to better understand the need for PABX use.
Methods: We conducted a retrospective, cohort analysis of CVAP placed (2007-2012) by two surgeons, in the operating room, at a university cancer center. We excluded patients currently receiving antibiotics and cases with concurrent surgical procedures. We evaluated whether PABX protected against CRI using propensity scores with matched weights. We used a total of 15 covariates, demographic and clinical, (see Table) with balance checked using standardized differences. Odds ratios (OR), 95% confidence intervals (CI), and p-values were reported for CRI at 14-day and 30-day totals.
Results:There were 1,091 CVAP placed, where 651 (59.7 %) received PABX and 440 (40.3%) did not. The majority, 95.7%, were placed in the internal jugular (n=1,044). The CRI rates for 14-day and 30-day totals were 0.82% (n=9) and 1.47% (n=16), respectively. Removal of CVAP occurred in 10 cases (63%). While results did not achieve statistical significance, use of PABX was associated with a clinically significant, 58%, reduction in the odds of 14-day CRI (OR=0.42, 95% CI: 0.05-2.28, p=0.34) and a 26% reduction of 30-day CRI (OR=0.74, 95% CI: 0.20-2.60, p=0.64).
Conclusion:This cohort analysis controlling for multiple covariates, examined PABX use in CVAP placement and found an overall lower rate of CRI. Although the results did not achieve statistical significance, the 58% reduction in odds of CRI within 14-days and 26% reduction within 30-days, point to clinically meaningful reductions in CRI when PABX are used. With so few CRI events, an extensive study, including thousands of patients would be required to achieve definitive results. The current findings are consistent with our previous research, suggesting a reduction in CRI with the use of PABX. Since treatment for a CRI can range from a course of oral antibiotics, or port removal and replacement, to admission for profound sepsis in an already immunocompromised patient, we suggest a conservative strategy of using PABX as the standard of care.
